Reconciling Primary Care and Specialist Perspectives on Prostate Cancer Screening

The Article in Brief

Richard M. Hoffman , and colleagues

Background This essay examines whether primary care clinicians should adopt guidelines developed by specialists. Different perspectives between primary care clinicians and specialists can create conflict when specialists propose screening guidelines. The case of prostate cancer screening in younger men illustrates this issue.

What This Study Found The authors argue that there is no direct evidence that starting PSA screening at age 40 years, as recently recommended by two specialty organizations, instead of the previously recommended age of 50 years has any impact on prostate-cancer-specific mortality. Although well-meaning, the authors assert, the specialty guidelines distract primary care physicians from providing services with proven benefit and value for patients. The US Preventive Services Task Force currently recommends delivering 35 adult preventive services, for which it finds high certainty of moderate or high net benefit - services that investigators estimate require 7.4 hours a day to deliver. Given the limited time in a typically rushed primary care visit, the authors conclude there is insufficient evidence that the benefits of starting PSA screening at age 40 years justify the additional counseling time.

Implications

• The authors call on primary care professional societies to vet specialty guidelines using evidence-based processes to determine which belong in primary care, thus enabling physicians to focus on providing patients services with proven effectiveness and value.
• The authors also call for primary care physicians and experts in evidence synthesis to participate on guideline review panels to ensure guidelines are based on systematic review of evidence and not solely on expert opinion.